Healthcare Provider Details

I. General information

NPI: 1942627500
Provider Name (Legal Business Name): MIRANDA ANN BERGMAN LPCC, CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 04/05/2026
Certification Date: 04/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3309 DIXIE HWY
ERLANGER KY
41018-4047
US

IV. Provider business mailing address

3149 MEADOWAY CT
INDEPENDENCE KY
41051-6717
US

V. Phone/Fax

Practice location:
  • Phone: 859-609-3893
  • Fax:
Mailing address:
  • Phone: 859-609-3893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number170788
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number70028929
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number161536
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: